Nanny, housekeeper and companion to the sick and elderly. These are just some of the many roles of undocumented domestic workers who came to America in search of better lives and found only exploitation, harassment and fear. Many have no legal recourse for injustices and work under the constant threat of deportation. Additionally, 9 out of 10 domestic workers do not receive health insurance from their employers, and one third of domestic workers cannot afford the medical care needed for themselves or their families.[i] As the United States moves toward politics and policies that are more exclusionary, undocumented domestic workers across the country struggle even harder to make ends meet.
By 2022, 33 million individuals will gain health coverage through the Affordable Care Act (ACA).[ii] However, this major effort to make health care affordable for more Americans also explicitly excludes undocumented workers from many provisions of the legislation, such as the expansion of Medicaid, the state-run health benefit exchange (which allows individuals and small businesses to purchase insurance at more affordable rates), and the elimination of the “pre-existing conditions” clause in insurance policies. Even immigrants with legal status cannot access federal health programs during the first five years of their permanent residency status. Furthermore, the ACA eventually eliminates the federal Medicaid disproportionate share hospital (DSH) funding, which hospitals use to cover the costs of providing uncompensated health care to low-income patients (including undocumented immigrants).[iii]
For the many undocumented domestic workers working low wage jobs in the United States, these exclusions from life-saving programs further reinforces their dehumanization, defining them by a single label. Although they take care of our children and elderly, they are publicly vilified, scapegoated in a struggling economy, and blamed for trends that have little to do with their legal status. In fact, talking-point accusations that undocumented immigrants are largely to blame for inappropriate emergency room (ER) use and for the rise in the insured population are simply unfounded. Non-citizens (legal and undocumented) only accounted for 22 percent of the non-elderly uninsured in 2006, while citizens made up the bulk of the uninsured (78 percent).[iv] Furthermore, non-citizens are significantly less likely to use the ER than citizens, and communities with higher concentrations of non-citizens tend to have lower rates of ER use.[v]
Undocumented workers are not the only ones who suffer because of marginalizing policies. Even the provisions that bar undocumented immigrants from public health programs have resulted in costly consequences that compromised coverage for citizens. After Colorado implemented tough measures requiring applicants to prove their eligibility for state benefits in 2006, it cost the state $2 million in the first year alone and state officials could not identify how many—if any—undocumented immigrants were denied public services.[vi] On the federal level, a study by the Government Accountability Office found that for every $100 spent by taxpayers on verification procedures in six states, Medicaid saved only 14 cents.[vii]
We all agree that the best solution is for the federal government to pass comprehensive, humane immigration reform that could turn uninsured undocumented workers into legal residents who pay into the system and can access it freely. In the meantime, many undocumented domestic workers, who have sacrificed everything for the chance at a better life for themselves and their families, are praying that they do not suffer injuries or illnesses.
However, there is hope that in the near future domestic workers will receive the recognition and appreciation they deserve and not be judged solely on their immigration status. In New York, where state lawmakers passed the groundbreaking Domestic Workers Bill of Rights, 200,000 domestic workers—including undocumented domestic workers—were finally given basic labor protections.[viii] And in California, the National Domestic Workers Alliance is pushing for a similar bill.
With new labor protections in place, we hope that the contributions of domestic workers, including those who work without legal status, are recognized, and that health care and other human rights will follow.
[i] Domestic Workers United and Datacenter, “Home is Where the Work Is: Inside New York’s Domestic Work Industry,” 2004.
[ii] Congressional Budget Office, “CBO and JCT’s Estimates of the Effects of the Affordable Care Act on the Number of People Obtaining Employment-Based Health Insurance,” March 2012.
[iv] Kaiser Family Foundation, “Summary: Five Basic Facts on Immigrants and Their Health Care,” March 2008.
[vi] Huyen Pham, Hoefstra Law Review, “Problems Facing the First Generation of Local Immigration Laws,” October 2008.
[vii] U.S. Government Accountability Office, “Summary of GAO and Staff Findings: Medicaid Citizenship Documentation Requirements Deny Coverage to Citizens and Cost Taxpayers Millions,” July 2007.